Mediastinal Mass in a Dog with What Is Your

Syncope and Abdominal Distension Diagnosis?

Kurt L. Zimmerman, DVM; John H. Rossmeisl Jr., DVM; Catherine E. Thorn, DVM, DVSc; Geoffrey K. Saunders, DVM, MS

Case Presentation
A
An 11-year-old, female spayed Golden Retriever was
presented to the Virginia-Maryland Regional College of
Veterinary Medicine with a 1-month history of progres-
sive abdominal distension, lethargy and intermittent
syncope. Diuretic therapy had been initiated 2 weeks
prior to referral. On physical examination, the dog was
8% dehydrated, hypothermic (rectal temperature 98°F),
moribund and in poor body condition.The dog also had
generalized subcutaneous pitting edema, expiratory
dyspnea, muffled ventral lung sounds, poor peripheral
pulses, faint heart sounds and abdominal effusion.
Fundic examination was unremarkable.
Results of a CBC revealed mild, normocytic, nor-
mochromic, nonregenerative anemia (HCT 31.5%, ref- B
erence interval 37.3-62.0%; RBC 5.25⫻106/µL, reference
interval 5.5-8.6⫻106/µL; hemoglobin 11.7 g/dL, refer-
ence interval 13.0-20.1 g/dL) and thrombocytosis
(688,000 platelets/µL, reference interval 179-473⫻
103/µL). Results of a serum biochemical profile revealed
hypoalbuminemia (1.9 g/dL, reference interval 2.7-3.9
g/dL), azotemia (BUN 68 mg/dL, reference interval 6.0-
28.0 mg/dL; creatinine 2.3 mg/dL, reference interval 0.8-
1.9 mg/dL), hypochloremia (106 mmol/L, reference
interval 109-120 mmol/L), and hyperphosphatemia (6.6
mg/dL, reference interval 3.0-5.0 mg/dL). Urine specific
gravity was 1.014, and a small number of calcium
oxalate crystals were noted on sediment examination.
Urinalysis results were otherwise unremarkable.
Indirect systolic/diastolic blood pressures were within Figure 1. Fine needle aspirate from a mediastinal mass in a dog.
normal limits. Wright’s stain, 100X (A), 200X (B).
Diagnostic and therapeutic thoracocentesis was
performed. Approximately 1.2 L of orange fluid was also was performed. Fluids aspirated from the thorax,
removed from the pleural space. Thoracic radiographs pericardium and abdomen were interpreted as modi-
taken after thoracocentesis identified pleural fissure fied transudates. On thoracic ultrasound examination, a
lines, an enlarged globoid-shaped cardiac silhouette, 10 cm long, hyperechoic, multinodular mediastinal
and dorsal displacement of the trachea. Echocardio- mass extending from the thoracic inlet to the ascending
graphic examination revealed pericardial effusion and aorta was identified. A percutaneous fine needle aspi-
significant biventricular hypertrophy. Pericardiocen- rate of the mediastinal mass was performed (Figure 1).
tesis with ultrasound guidance yielded 900 mL of
serosanguinous fluid. Diagnostic abdominocentesis (Continued on next page)

From the Departments of Biomedical Sciences and Pathobiology (Zimmerman, Thorn, Saunders), and Small Animal Clinical Sciences (Rossmeisl),
Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24061. Address correspondence to Dr. Zimmerman
(kzimmerm@vt.edu).

Vol. 29 / No. 1 / 2000 Veterinary Clinical Pathology Page 19

 Mediastinal Mass in a Dog with Syncope and Abdominal Distension

Cytologic Interpretation
A
Examination of the aspirate revealed a moderately cel-
lular sample of good quality. The predominant nucleat-
ed cells were arranged individually and in monolayers
of variably sized sheets. The cells were ~20 µm in diam-
eter, uniform in appearance, and oval to polygonal in
shape; they had indistinct cell borders and displayed
mild anisocytosis. Nuclei were round to slightly oval
and eccentric, with coarsely stippled chromatin, promi-
nent multiple round nucleoli, and moderate aniso-
karyosis. The N:C ratio was low to moderate with abun-
dant, agranular, lightly eosinophilic cytoplasm. Free
nuclei were commonly observed among the cell clusters
and individual intact cells. In the background were
numerous RBC; platelets were not observed. Leukocyte B
numbers were compatible with the degree of peripher-
al blood contamination. No organisms or other cell pop-
ulations were noted. The primary differential diagnosis
was a neuroendocrine tumor, likely chemodectoma;
however, epithelial neoplasms originating from thyroid
follicular or parathyroid tissue, and thymoma, also were
considered. A tentative diagnosis of chemodectoma was
made based on the cytologic features. Thymoma was
ruled out because of the lack of lymphocytes.The lack of
blue-black cytoplasmic pigment (seen in a small per-
centage of thyroid adenomas and carcinomas) or extra-
cellular colloid, made a thyroid follicular cell tumor less
probable. Hyperparathyroidism was not suggested by
Figure 2. Histologic section of a malignant aortic body tumor
the clinical biochemical results.1 In addition, parathy- (chemodectoma) in a dog. (A) Aggregates of neoplastic cells are
roid tumors in the dog are quite rare. The owners elect- separated by fine fibrovascular septa. H&E, 50X. (B) Cuboidal to
ed euthanasia for the dog. polygonal neoplastic cells with abundant purple cytoplasm, fine
cytoplasmic granules and round, open nuclei. H&E, 100X.
Necropsy and Histopathologic Findings
figures were noted. A fibrous capsule surrounded the
Hydrothorax, hydropericardium, ascites, and general- mass, and evidence of capsular invasion by the malig-
ized subcutaneous edema were identified at necropsy. A nant cells was observed. The histologic findings were
tan, hemorrhagic, multinodular mass encircled the base consistent with a malignant chemodectoma of the aor-
of the aorta and brachiocephalic trunk and extended tic body.
10 cm cranially into the mediastinum. The left and right The adrenal medullary mass was composed of
cardiac ventricles were hypertrophied, and the liver and polygonal clusters and cords of malignant medullary
lungs were congested.The right adrenal gland was twice cells that extended into the adrenal cortex, with evi-
normal size, measuring 2 cm⫻1 cm. The adrenal cortex dence of adrenocortical compression and destruction.
was thin, and the medulla contained a hemorrhagic The histologic diagnosis of the adrenal mass was
brown mass. pheochromocytoma.
Histologically, the mass surrounding the aorta and
brachiocephalic trunk was composed of cells in multi- Discussion
ple lobules separated by fibrous septa and subdivided
into smaller aggregates by a fine fibrovascular network Chemodectomas are relatively rare neoplasms of the
(Figure 2). The neoplastic cells were large, cuboidal to chemoreceptor organs seen primarily in dogs, but also
polygonal, and had abundant purple cytoplasm con- in cats, horses, and human beings.2-4 Brachycephalic
taining fine cytoplasmic granules and occasional vac- breeds are more commonly but not exclusively affect-
uoles. Nuclei were round, with an open chromatin pat- ed.5 In dogs, the tumor usually arises from the aortic
tern. There was marked anisokaryosis, but no mitotic body rather than from the carotid body, with a relative

Page 20 Veterinary Clinical Pathology Vol. 29 / No. 1 / 2000

 Zimmerman, Rossmeisl, Thorn, Saunders
frequency of 4 to 1.2,6 Chemodectomas are usually
benign; however, carcinomas have been reported.
Metastases occur in about 30% of cases, and often
involve vertebrae, lung, regional lymph nodes, liver,
pancreas and kidney.2,7 The main threat posed by a
chemodectoma is through its anatomical location at the
base of the heart, which can result in compromised car-
diac function and blood flow, and lead to congestive
heart failure and reduced cardiac output. These effects
explain both the syncope and the effusions seen in this
dog.8 Because the tumor is intertwined with the great
vessels in the thoracic cavity, surgical resection is often
not possible.6
Differential diagnoses for a heart-base mass include
hemangiosarcoma, chemodectoma, lymphosarcoma,
thyroid follicular cell tumor, thymoma, mesothelioma,
parathyroid tumor and metastatic neoplasia. Heman-
giosarcoma has a prevalence 10 times that of the next
most common tumor, chemodectoma.8 As demonstrat-
ed in this patient, aspiration of pericardial fluid may fail
References
1. Shull RM, Maddux JM. Subcutaneous glandular tissue: mam-
mary, salivary, thyroid, and parathyroid. In: Cowell RL, Tyler
RD, Meinkoth JH, eds. Diagnostic Cytology and Hematology of the
Dog and Cat. 2nd ed. St. Louis, Mo: Mosby; 1998:88-96.
2. Capen CC. Chemoreceptor organs. In: Jubb KVF, Kennedy PC,
Palmer N, eds. Pathology of Domestic Animals. 4th ed. San
Diego, Calif: Academic Press; 1993:345-347.
3. Levy M, Stegelmeier BL, Hudson LM, et al. Chemodectoma in
a horse. Can Vet J 1990;31:776-777.
4. Tillson DM, Fingland RB, Andrews GA. Chemodectoma in a
cat. J Am Anim Hosp Assoc 1994;30:586-590.
5. Cobb MA, Brownlie SE. Intrapericardial neoplasia in 14 dogs.
J Sm Anim Pract 1992;33:309-316.
Vol. 29 / No. 1 / 2000 Veterinary Clinical Pathology
to reveal a malignant cell population.5,9 However, ultra-
sound guided or blind aspiration of the mass can pro-
vide diagnostic cytologic material, as also was demon-
strated in this case.4 Direct aspiration should be encour-
aged, as it will greatly increase the odds of making a
cytologic diagnosis of neoplasia.
About 60% of dogs with chemodectomas, like the
dog in this case, have additional tumors, including thy-
roid carcinoma, interstitial cell tumor, benign mast cell
tumor, seminoma, malignant melanoma, Sertoli cell
tumor and pheochromocytoma.2,6 A thorough physical
examination is warranted to rule out concurrent neo-
plasia. ◊
Acknowledgements
The authors thank Dr. G. Daniel Boon for funding support
and manuscript preparation.
Key Words: Aortic body tumor, canine, chemodectoma, cytology
6. Owen TJ, Bruyette DS, Layton CE. Chemodectoma in dogs.
Compend Cont Educ Pract Vet 1996;18:253-265.
7. Callanan JJ, McNeil PE, Andersen TJ, Laird H. Metastatic aor-
tic body tumour causing neck pain in a dog. J Sm Anim Pract
1991;32:525-528.
8. Ware WA, Hopper DL. Cardiac tumors in dogs: 1982-1995. J Vet
Int Med 1999;13:95-103.
9. Kerstetter KK, Krahwinkel DJ, Millis DL, Hahn K.
Pericardiectomy in dogs: 22 cases (1978-1994). J Am Vet Med
Assoc 1997;211:736-740.
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